Objective: To compare phacoemulsification with extracapsular cataract surge
ry in patients with diabetes and to identify determinants of postoperative
visual acuity,
Design: Prospective, randomized, paired-eye trial.
Participants.. Forty-six patients with diabetes and bilateral cataract.
Intervention: Patients were allocated to phacoemulsification surgery with s
ilicone intraocular lens to one randomly determined eye, and extracapsular
cataract surgery with 7-mm polymethylmethacrylate intraocular lens to the o
ther.
Main Outcome Measures: Logarithm of minimum angle of resolution visual acui
ty (logMAR VA), incidence of clinically significant macular edema (CSME), r
etinopathy progression, indices of anterior segment inflammation, and incid
ence of capsulotomy.
Results: Compared with eyes undergoing phacoemulsification, eyes managed wi
th extracapsular surgery had more anterior chamber cells (P = 0.0004) and f
lare (P = 0.007) 1 week after surgery and a higher incidence of posterior s
ynechiae (P = 0.04) and intraocular lens deposits (P < 0.0005) in the first
postoperative year. The need for posterior capsulotomy was greater in eyes
undergoing extracapsular surgery (16 of 46 vs. 5 of 46, P = 0.01), No diff
erence in incidence of postoperative CSME, progression of retinopathy, or d
evelopment of high-risk proliferative retinopathy was identified between te
chniques (P = 1,0, 0,8, and 0,2), Median 1 year logMAR VA was worse in eyes
undergoing extracapsular surgery (0.08 vs. 0,06, P = 0,02), especially in
those with retinopathy (0.14 vs. 0.08, respectively; P = 0,01), The presenc
e or absence of CSME at the time of surgery was the most significant determ
inant of I-year logMAR VA in regression models for both extracapsular (P =
0,0004, R-2 = 0.45) and phacoemulsification groups (P < 0,00005, R-2 = 0,46
),
Conclusions: Phacoemulsification is associated with better postoperative VA
, less postoperative inflammation, and less need for capsulotomy than extra
capsular cataract surgery in patients with diabetes. However, with both tec
hniques, the principal determinant of postoperative VA appears to be the pr
esence or absence of CSME at the time of surgery. Early intewention, reduci
ng the risk that unrecognized CSME is present at the time of surgery, may b
e more critical to outcome than choice of surgical technique. (C) 2000 by t
he American Academy of Ophthalmology.